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Swollen arm, numbness, tingling, EKG done, taken Motrin and Vicodin, painful. What can it be?

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Hello, my husband is a 38 y/o white male, 6'1, 235lbs but in very good shape and currently has 48inch shoulders and 38inch waist now but he's gained 20lbs in the last 4 months so his waist has gained 4 inches in that time. He smokes a pack a day for 20 years. Does not drink alcohol at all. No drug use. No DM. He's active military - Navy Chief.

Hx: He has severe sleep apnea [diagnosed 2 weeks ago, CPAP on its way], tennis elbow, another torn miniscus, constant severe pain in both knees and both hips [multiple xray and MRI have both come back clean and hisdoctors are dumbfounded]. He has had knee surgery for torn miniscus 3 years ago, has had pneumonia 5 times, food poisoning on the boat 7 times and the "Mystery XXXXXXX Flu" that apparently everyone on the XXXXXXX XXXXXXX gets 10-30 days afterboarding the ship [but he hasn't been on the XXXXXXX for over a year and a half. He said he's had the weird tingling for several years but it usually "comes and goes" lasting about 5-15 minutes but now, there is swelling which has never happened before. He has been ruled out for CHF, RA, SLE, MS. His family has NO Hx of CHF, CVA, cardiac problems, no arthritis, no DM. He complains of constantly being exhausted and occasional spouts of feeling "high" [for like of a better description] where he feels he has a head full of wool, like feeling like being REALLY drunk but knowing he shouldn't feel that way, the low cognitive skills, word slurring, dizziness. His mother did tell me that she has had the same tingly/prickley sensation in her right arm so I don't know if there's a genetic factor. He sporadically gets ocular migranes [he can have none foryears then about 10x a month to 4 a day in a month] His cholesterol is normal, he does not have high BP, no fevers [other than the pnuemonia and foodpoisoning, he's never sick, no fevers, no rashes, no swollen lymph nodes, no bilateral pain, no seizures, no strokes, etc.

He has been complaining of many things but the real complaint is the major pain in his right arm. His right arm is swollen [shoulder to finger tips], and the swelling has been ongoing for about a month. He described the feeling in his arm as 3 stages: stage 1, desensitizing sensation that starts in the tip of his thumb, then goes to the first finger to the pinky o the had. Stage 2: cold tingling/prickely sensation tstarts to rapidly spread to his entire hand. Stage 3: the tingling sensation spreads to his entire arm almost instantly and his entire arm up to his shoulder and then the entirearm feeling like it is on fire along with numbness and tingling. The tingling and burning is reported on a 10/10 pain scale continuing for about a month. The doctors have done extensive EKG's, full blood panels, XXXXXXX panels, thyroid panels... they've pretty much ruled out many possible diseases/syndromes but noone can tell us wha he's got. His shrink thinks he also has sjogren's syndrome because he's always drinking something otherwise his lips dry out and he feels like his eyes are full of sand.

Meds: He has been Rx'd Motrin,and Vicodin for the pain but he rarely takes the vicodin. Prior, he was Rx'd Celebrex because he had pain in his back, knees, and 2 nuckles but his MD took him off of it after a month because that's when we estimate the symptoms started and she wasnt sure if his symptoms may have been caused by Celebrex. Now, a month off of Celebrex, his symptoms continue.

Currently, he's in constant pain ranging 7/10 to 10/10 constantly. His Rheumatologist has ruled out OA and RA but said he has arthritis in his sternum [I'm not a doctor but it's the first timeI heard that one], and his 3rd and 4th right fingers, along with tennis elbow in this right arm. He is fatigued all the time, he now has mood swings because of the constant pain, and all his doctors don't know what's wrong with him other than the 90% chance he has Sjogrens.

All his doctors are out of ideas. What can it be? What other info can I offer/questions I can answer?
Posted Fri, 29 Jun 2012 in General Health
Answered by Dr. Anil Grover 6 hours later

Thank you for writing in.

I read details so well compiled with diligence. I will offer my analysis of the patient and may be with followup questions both of us can get an idea for the treating doctors to work on.

1. Cardiology first, it has been concluded that he has no cardiac illness. I Agree.
Though, he has one or two definitely modifiable risk factor that is smoking and
Secondly he has recently gained weight and walked into Waist/Hip ratio of >1-
That is considered by some of cardiologist as risk factor.

2. His upper limb symptoms and available signs are suggestive of either XXXXXXX
venous thrombosis (pain- and swelling). Pain and swelling could be due to
myositis but added tingling & burning sensation involvement of irritation of nerve
into picture. So, the first to be answered in follow up question is: Has he been
investigated for cervical spondylosis, thoracic outlet syndrome and compressive
or idiopathic radiculo- myelopathy? Can you share the reports? He obviously has
localisation of a possible systemic disease to neurovascular & muscular segment
of right arm.

3. Pertinent question is whether a systemic disease akin to vasculitis explain his
present status? Two diseases come to mind one is Overlap Syndrome and the
other is mixed connective tissue disorder, well managed by Rheumatologists.
Both notorious for varied presentations and mixed bag of investigative results.
Both have some features on basis which his diagnosis of some form of vasculitis
was entertained at various times.

4. yes Ma'm, I have also heard of arthritis of sternum but in those cases pain is
confined to ribs and sternum. Here major pain is at least an arm's length away.

Treatment: Mainstay, till a diagnosis is made will remain analgesics and best analgesic is which relieves his pain. Once a specific diagnosis is made real treatment can begin. Your husband does not appear to be much complaining type or you have absorbed all the stress which goes along with chronic un-diagnosed illness.

I expect couple of follow up questions, I shall be happy to take those.

Best Wishes.

Dr Anil Grover
MBBS, MD(Internal Medicine) DM(Cardiology)
Above answer was peer-reviewed by
Follow-up: Swollen arm, numbness, tingling, EKG done, taken Motrin and Vicodin, painful. What can it be? 8 hours later
Hello Doctor,

He has been ruled out for DVT, his platelets and WBC counts are well within normal limits, with platelets at 200,000 [normal is considered 150,000 to 350,000], and negative Homan's sign. They have not done a Doppler on his shoulder/arm when he went to the Emergency Room, the doctors there gave him analgesics and toldus they do not do diagnostics and his bloodwork did not suggest DVT.

I do not know if they checked him for cervical spondylosis, is that something that would be seen with xrays or MRI? I would assume that he would have chronic neck pain or that Xray or MRI would show something. I asked him again this morning about the neck pain and he said he actually has not had neck pain but if he overworks his back, he will get XXXXXXX muscle pain in between his shoulder blades and if he REALLY overworks hisback, it will hurt to the point where he cannot twist or reach over.

I looked at his right leg this morning and I think the right side or his body is swelling because he now has 2 blisters on his right foot from where the top of his boots rub. I checked for pitting edema and it's not pitting, maybe almost a 1 on a 1-4 scale but he said he did not notice until just today. There is no pain, reddness,coldness, no tingling, no abnormal sensations but I'm sure swelling is not normal, and it's only the right foot. I checked Homan's just in case and it's negative.

He brought back some lab work results his Rheumatologist gave him. I don't know if it will help but here are the results:

RF - 9.7 [normal is 0-13 IU/mL]
ESR - 14 [normal is 0-15 mm/hr]
glucose - 91 [normal is 75-110]
BUN/Creat, Na,K, Cl,CO2, and CA all within normal limits
Protein total 7.7, albumin 4.1, AST 25, ALT 41, Alk Phos 93, bilirubin 0.8,
TSH 2.16.

RNP ENA -negative XXXXXXX ENA- negative
SSA AB- negative
dsDNA- SLE 45%, SLE 28%, MCTD 12%, SJOGREN'S 6%, SCLERO 9%, POLYMYO <2%
Centromere - SLE 12%, SLE 3%, MCTD 7%, SJOGREN'S <2%, SCLERO 27%, POLYMO <2%

DNA DS AB- 1 [normal is 0-4]
XXXXXXX SCR - Positive H

That's his latest labs for the last weeks.

I do not think they tested him for thoracic outlet syndrome or radiculopathy [they would have told us/asked for consent right?] but I know he's scheduledfornerve conduction study next week.

You are absolutely right, he is not a complainer but I can see when he's in pain and until a few months ago, he would seldom admit when he's in pain.

Thank you for your help, every possiblility and all possible information is very helpful. Please let me know if there's anything else I can add.

Thank you
Answered by Dr. Anil Grover 3 hours later

Thank you for your patience in replying to my questions! Three additional issues has been raised in your this letter and let us deal with those:
1. Your question about cervical spondylitis, in fact all the nerves carrying motor (activity) fibers to and sensory fibers from part of body between abdomen and jaw including both upper limbs connect to spinal cord via spaces normally present in bony spine of neck region. A doubt had come to my mind when disease invoving nerves were chiefly present in right arm but involvement right leg takes that suspicion rather lower in the differential diagnosis.
2. You have described in detail about right foot. To me it appear that sensations are a shade dimnished for he never complained of blisters you noticed. This needs exclusion of peripheral neuropathy among other things and he is scheduled for nerve conduction test. Let us wait for the result. Neurologist evaluation will help.
3. XXXXXXX Screen has come out to be positive with SSA B positive. From here it is better managed by Rheumatologists and fortunately they are in picture. Vasculitis, Sjogren's are high on cards.

My personal feelings are that you are not only brave but astute lady and you have team of most competent doctors it is only matter of time that an accurate diagnosis will be established. If you have any query for me I will be most happy to answer.

Best Wishes.

Dr Anil Grover
Above answer was peer-reviewed by
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